Ebola outbreak - general thread #8

[annahanna]

As far as I can tell Louise moved to US a long time ago and didn't have a daughter that died in Liberia. Also she and Mr. Duncan have a son (who is very much alive and lives in US), not a daughter.
Mr. Duncan was renting a room from a family whose pregnant daughter died from Ebola.
So the pregnant woman who died wasn't his daughter as far as I can tell.

In addition to the son she shared with Duncan, Louise had a younger son (13 or so) and the 2 older daughters in Texas. She also had two older sons in Liberia and an older daughter in Liberia who died "in childbirth" earlier this year. Familial relationships are culturally very different in Liberia. Just as the 35 year old daughter repeatedly referred to the 45 (various ages have been reported from 42 to 45) year old Duncan as "my Daddy," he may have referred to Louise's daughter in Liberia as his own.

 

[rabidstoat]

I think I missed a critical half day or so, and am still trying to understand the quarantine.

Is this the nurse who registered a fever with a forehead thermometer, but then had multiple normal readings with an oral thermometer?

I'm trying to understand why she's quarantined. She doesn't seem symptomatic. She did work with Ebola patients, in protective gear. There are people at Emory and Omaha and Bellevue who are working with Ebola patients, in protective gear. But so far as I know, they're not quarantined, right?

Why is she quarantined and not others who work with Ebola patients? Is it simply the fact that she came from overseas, and the policy maker decided they didn't trust things over there? Are local health workers quarantined in tents and I've not heard about it? Did she initially register a fever on a forehead strip?

This seems very confusing and unnecessary to me.

 

[chipmunk]

Indeed. IMO quarantine falls under the "suck it up, buttercup" rule once it's in place, though as I mentioned, I also think the first one was not optimally handled. Coming back from a long stressful trip like that and being quarantined suddenly would be difficult to wrap your head around. I do feel for the nurse for that reason, but it is not a civil rights violation, IMO. No doubt it will get better with time. JMO.

This is my last post here, take care all.

Thank you for your valuable educational contributions. Much appreciated, take care.

 

[chipmunk]

I think I missed a critical half day or so, and am still trying to understand the quarantine.

Is this the nurse who registered a fever with a forehead thermometer, but then had multiple normal readings with an oral thermometer?

I'm trying to understand why she's quarantined. She doesn't seem symptomatic. She did work with Ebola patients, in protective gear. There are people at Emory and Omaha and Bellevue who are working with Ebola patients, in protective gear. But so far as I know, they're not quarantined, right?

Why is she quarantined and not others who work with Ebola patients? Is it simply the fact that she came from overseas, and the policy maker decided they didn't trust things over there? Are local health workers quarantined in tents and I've not heard about it? Did she initially register a fever on a forehead strip?

This seems very confusing and unnecessary to me.

:goodpost:

 

[Muffet]

The Ebola Wars
How genomics research can help contain the outbreak

http://www.newyorker.com/magazine/2014/10/27/ebola-wars

Thank you so much for this. :thumb: I'm eager to read it tonight and know I can recommend it! I've been following Gire's* work with great interest. I'll post a link to a summary that includes a link to the most fascinating study, for those who are interested.

Hidden behind the noise from all the fumbling, bickering, and politicizing, THIS is where the rubber meets the road.

We need a vaccine.

We cannot eradicate ebola; it's a zoonotic virus that, at best, merely recedes back into its reservoir (ie, bats) in the rainforest, until the next time. The next times will come more frequently, for a few reasons.

The good news is that mutations it undergoes while within such other species are not assisting in its adaptation to humans.

But the mutations it has already undergone through this human outbreak have been massive, and some significant. (This doesn't mean it's going airborne (that would be unprecedented) or even necessarily more deadly - in fact, to survive better among humans, it would be more successful if it kept us alive longer, like HIV/AIDS.)

So we need to stop further transmissions ASAP, to stop this galloping adaptation to humans. And we must do all we can to develop a vaccine that can keep up with future mutations.

I'll shut up now. This is my area, and I find it so fascinating I... go on.

*Along with that of his cohorts - unsung heroes who have not survived through the last several months. May they RIP and someday receive acknowledgment for their work.

http://news.harvard.edu/gazette/story/2014/08/ebola-genomes-sequenced/

http://m.sciencemag.org/content/345/6202/1369

 

[jjenny]

I think I missed a critical half day or so, and am still trying to understand the quarantine.

Is this the nurse who registered a fever with a forehead thermometer, but then had multiple normal readings with an oral thermometer?

I'm trying to understand why she's quarantined. She doesn't seem symptomatic. She did work with Ebola patients, in protective gear. There are people at Emory and Omaha and Bellevue who are working with Ebola patients, in protective gear. But so far as I know, they're not quarantined, right?

Why is she quarantined and not others who work with Ebola patients? Is it simply the fact that she came from overseas, and the policy maker decided they didn't trust things over there? Are local health workers quarantined in tents and I've not heard about it? Did she initially register a fever on a forehead strip?

This seems very confusing and unnecessary to me.

These new rules were passed after Dr. Spencer, who worked in West Africa, also in PPE, came down with Ebola.
Dr. Spencer was self-monitoring (which included checking temperature twice a day). But while self-monitoring, he was using public transportation, and going to public places. So then after he came down with it, the new rule was passed to prevent that.

 

[annahanna]

Kaci also has experience working with the media explaining scientific topics. I found this in her bio and other info I can't post or link here. It's disturbing her treatment by NJ and the hospital brought her to tears. This really upsets me.

Perhaps she was just turning on the waterworks for the media? In my opinion, she came across to me in her interviews as less then genuine. Her talking points were too slick. Her complaints were too outrageous. She has already hired a very smooth attorney to file a lawsuit first thing Monday morning.

Ms Hickox, as a former CDC employee and a Doctors Without Borders employee (they are paid for their service) is well aware of what a infection containment tent looks like. She is currently in a room at the hospital inside an infection containment tent. She has heat, electricity, cell service, wifi, hot meals, amt access to a toilet. The self contained toilet is in use because it was the only way to get toilet facilities inside the containment structure. Obviously, the hospital does not have isolation rooms with separate heating/ventilation/air conditioning systems. Just putting her in a private room would not protect other patients in the hospital if she were to become infected. (Yes I understand Ebola is transmitted through bodily fluids, BUT, the 4 Ebola prepared hospitals all have truly self contained rooms. They are doing their best to mimic that.) The fact that she is a former CDC employee (who vigorously oppose the quarantine) who just happened to be the first person quarantined, and just happens to be highly vocal is suspicious to me. Especially since one of the first articles I read about her contained a reference to this text exchange. "Kaci’s mother said she had sent Kaci a text thought asking her daughter if she thought she would be detained when she returned home: “She texted back: LOL that’s not going to happen.” http://newusnews.com/tested-negative-nurse-criticizes-her-quarantine/. I have seen this in a number of early media reports, but non of the later stories. Ms Hickox knew, or should have known, that quarantine was a possibility.

 

[jjenny]

She was the first person quarantined under these new rules, so I don't see how she should have known. How do they mimic self-contained room by using a tent? Does this tent have a negative air flow? I doubt it. How is she going to take a shower in that tent? Do they expect her to sit there for 3 weeks without shower?
They've quarantined people who had contact with Mr. Duncan in his apartment for first four days. Then they were moved to a regular house in a gated community. The rest of Mr. Duncan's contacts were quarantined in their apartments.
They are quarantining Dr. Spencer's fiancée in her apartment.
Why does this nurse have to sit in a tent?

 

[Muffet]

I just remembered something else I've been wanting to point out.

There's an apparent lack of understanding, even among health professionals, about what "quarantine" is. It's continually conflated with "isolation," and that's not a benign mistake.

So, to clarify, QUARANTINE is for people who are NOT sick, but are on watch. People who do get sick, or have otherwise been found to have been infected, are placed in ISOLATION.

I hope understanding the distinctions will reduce some confusion and questions about why apparently healthy people are quarantined. That is, by definition, how quarantine works.

(I will add that the terrible fumbling of the NJ quarantine is inexcusable and makes it more difficult for us to gain acceptance and understating of such a useful practice.)

 

[chipmunk]

http://news.yahoo.com/u-envoy-west-africa-see-world-failing-ebola-093520593.html

Guinea harness's new physician graduates and retired ones into a kind of national service.
Powers is in West Africa seeing how the world is failing in the fight against Ebola first hand.

 

[CarmelEyesD]

http://nypost.com/2014/10/27/5-year-old-boy-being-tested-for-ebola-in-new-york-city/

A 5-year-old boy who just returned from West Africa was transported to Bellevue Hospital Sunday with possible Ebola symptoms, according to law-enforcement sources.

The child was vomiting and had a 103-degree fever when he was carried from his Bronx home by EMS workers wearing hazmat suits, neighbors said. “He looked weak,” said a neighbor.

 

[CarmelEyesD]

http://www.wmcactionnews5.com/story...ts-to-possible-ebola-case-in-memphisCommunity reacts to possible ebola case in Memphis

MEMPHIS, TN (WMC) -

The patient currently being tested for ebola is resting comfortably in isolation at Methodist University Hospital, but first arrived at Methodist South in Whitehaven.

As tests happen inside, people outside of the facility are speaking about how they feel.

Shay Jones was recently released from MUH for an unrelated illness, and was shocked to hear someone is being tested for ebola.

Ebola scare: Doctors establish alternate diagnosis

Doctors at Methodist University Hospital have successfully isolated a patient who tested negative for the Ebola virus.

Methodist University Spokesperson Mary Alice Taylor says they established a primary alternate diagnosis, meaning the patient could be sick with another illness that causes similar symptoms. The patient is in stable condition in an area separate from the main hospital on the MUH campus.

http://www.msnewsnow.com/story/27017813/possible-ebola-case-at-methodist-university-hospital

 

[annahanna]

She was the first person quarantined under these new rules, so I don't see how she should have known. How do they mimic self-contained room by using a tent? Does this tent have a negative air flow? I doubt it. How is she going to take a shower in that tent? Do they expect her to sit there for 3 weeks without shower?
They've quarantined people who had contact with Mr. Duncan in his apartment for first four days. Then they were moved to a regular house in a gated community. The rest of Mr. Duncan's contacts were quarantined in their apartments.
They are quarantining Dr. Spencer's fiancée in her apartment.
Why does this nurse have to sit in a tent?

Ms Hickox is not in a garden variety tent in the hospital parking lot as she has tried to portray. She is hospitalized inside the hospital, in a large room that has a specially designed hazmat/isolation negative pressure tent set up inside. She is inside that protective tent for the health and well being of other patients inside the hospital because the University Hospital must not have a negative pressure separate HVAC room. Here is a link to a company that makes these types of tents. http://www.egozlin.cz/en/page/3535.isoloation-under-pressure-tent-es-56lp/

Ms Hickox was admitted to University Hospital late in the day on Friday. As of this moment, it is very early Monday morning. She has not given the hospital or the NJ health department the time to complete an appropriate evaluation of her health or living situation or time to set up an alternate quarantine location for her. Since she had intended to go to Maine, to an area that only has a temporary hospital facility meant to triage patients and send them to one of their 4 Ebola treatment centers, sending her to Maine may not be the safest choice. (But she really has not given anyone time to determine that.) Dr Spencer's fiancée was hospitalized in isolation at first also. She was just recently allowed to go home to her decontaminated apartment where she will be under 24 hour guard with a police presence right outside her door. She is not being allowed visitors and deliveries will be left outside her door for her to retrieve. Unfortunately, Ms Hickox's actions make it questionable (at least to me) if she would follow voluntary quarantine guidelines. No one has any way to know if she will become ill with ebola. She was exposed to the disease just hours before her flight home. In mi opinion, she needs to show the same concern and compassion for American citizens that she reportedly showed to her patients in West Africa.

*edited to add
Duncan's friends and family were exposed only to him and all denied having taken intimate care of him. Duncan's health care team was under self monitoring and two of them became ill with ebola. dr Spencer's fiancée was exposed only to him and was reportedly exposed before vomiting or diarrhea symptoms emerged. She was initially quarantined at the hospital. After a brief period of monitoring, she was allowed to go home under police guard. Ms Hickox treated numerous patients in their final stage of ebola. By her own account, hours before boarding her plane for the flight home, she held the hand of a child dying from ebola. She has only been in isolation in isolation since Friday evening. She needs to have just a little patience IMO.

 

[Sonya610]

Perhaps she was just turning on the waterworks for the media? In my opinion, she came across to me in her interviews as less then genuine. Her talking points were too slick. Her complaints were too outrageous. She has already hired a very smooth attorney to file a lawsuit first thing Monday morning.

I completely agree! And her use of the term "human rights" was truly over the top. She is a U.S. Citizen on U.S. soil so civil rights would apply, not HUMAN rights. She SURELY knows that yet she intentionally chose that term so her stance on quarantine would include non-citizens as well.

If she really wanted to get OUT of quarantine or have a better situation she would have suggested alternatives in the video instead of just spewing propaganda and using hot words.

It is also interesting that the FIRST person held under the new quarantine just happens to have experience writing and delivering speeches and also has ties to the CDC.

 

[Brightbird]

Well, looks like Australia's gotten tough and isn't allowing visitors, including asylum seekers, from the affected countries.

http://www.abc.net.au/news/2014-10-27/government-visa-applilcations-ebola/5845048

The minister told Parliament the country's humanitarian program, along with the immigration program, had been temporarily suspended.

"These measures include temporarily suspending our immigration program, including our humanitarian program, from Ebola-affected countries, and this means we are not processing any application from these affected countries," he said.

"And other permanent visa holders who haven't arrived in Australia are being required to submit to a 21-day quarantine period prior to departure to Australia."

"We are cancelling and refusing non-permanent or temporary visas from persons from Ebola-infected countries who haven't departed yet for Australia," he said.

 

[nrdsb4]

Just want to respond to the comments about Presby Dallas possibly putting their HCW up in a hotel:

It was I who speculated that they may have put them in their "Hospitel," which is a hotel within the Main building of their hospital. The hotel is generally used by out of town relatives of patients, so that they can be in close proximity to their family member. Additionally, some of the ambulatory surgery centers within the professional buildings attached to the hospital send their patients there so that the patient feels comfortable that they will be close to the hospital in the event of a complication.

I don't know for sure if they HCW are staying there, it just seemed plausible to me.

 

[musicaljoke]

Just want to respond to the comments about Presby Dallas possibly putting their HCW up in a hotel:

It was I who speculated that they may have put them in their "Hospitel," which is a hotel within the Main building of their hospital. The hotel is generally used by out of town relatives of patients, so that they can be in close proximity to their family member. Additionally, some of the ambulatory surgery centers within the professional buildings attached to the hospital send their patients there so that the patient feels comfortable that they will be close to the hospital in the event of a complication.

I don't know for sure if they HCW are staying there, it just seemed plausible to me.

In any case, this knee-jerk manner of quarantine is expensive, unnecessary, and unsustainable. Toronto quarantined 23,000 people during the SARS outbreak. How will a large scale quarantine be managed in NY or NJ? It's hard for me to imagine that any qualified health authorities were involved in the decision to quarantine individuals in such an absurd manner.

 

[Footwarrior]

Nurse Hickox is being handled as if she had the disease. But in fact she tested negative for the virus and shows no symptoms. And now we are hearing the hate directed at this lady along with implications that she is part of some evil agenda.

Here is the screwy part. The NJ quarantine rule does not apply to local health workers like those treating the doctor in Belleview Hospital. It only applies to people like Nurse Hickox who dare to help the people of Africa.

 

[SStarr33]

Ms Hickox is not in a garden variety tent in the hospital parking lot as she has tried to portray. She is hospitalized inside the hospital, in a large room that has a specially designed hazmat/isolation negative pressure tent set up inside. She is inside that protective tent for the health and well being of other patients inside the hospital because the University Hospital must not have a negative pressure separate HVAC room. Here is a link to a company that makes these types of tents. http://www.egozlin.cz/en/page/3535.isoloation-under-pressure-tent-es-56lp/

Ms Hickox was admitted to University Hospital late in the day on Friday. As of this moment, it is very early Monday morning. She has not given the hospital or the NJ health department the time to complete an appropriate evaluation of her health or living situation or time to set up an alternate quarantine location for her. Since she had intended to go to Maine, to an area that only has a temporary hospital facility meant to triage patients and send them to one of their 4 Ebola treatment centers, sending her to Maine may not be the safest choice. (But she really has not given anyone time to determine that.) Dr Spencer's fiancée was hospitalized in isolation at first also. She was just recently allowed to go home to her decontaminated apartment where she will be under 24 hour guard with a police presence right outside her door. She is not being allowed visitors and deliveries will be left outside her door for her to retrieve. Unfortunately, Ms Hickox's actions make it questionable (at least to me) if she would follow voluntary quarantine guidelines. No one has any way to know if she will become ill with ebola. She was exposed to the disease just hours before her flight home. In mi opinion, she needs to show the same concern and compassion for American citizens that she reportedly showed to her patients in West Africa.

*edited to add
Duncan's friends and family were exposed only to him and all denied having taken intimate care of him. Duncan's health care team was under self monitoring and two of them became ill with ebola. dr Spencer's fiancée was exposed only to him and was reportedly exposed before vomiting or diarrhea symptoms emerged. She was initially quarantined at the hospital. After a brief period of monitoring, she was allowed to go home under police guard. Ms Hickox treated numerous patients in their final stage of ebola. By her own account, hours before boarding her plane for the flight home, she held the hand of a child dying from ebola. She has only been in isolation in isolation since Friday evening. She needs to have just a little patience IMO.

annahanna, you need to go to NJ and act as Christie's spokesperson on this case. Excellent posts.

 

[SStarr33]

I completely agree! And her use of the term "human rights" was truly over the top. She is a U.S. Citizen on U.S. soil so civil rights would apply, not HUMAN rights. She SURELY knows that yet she intentionally chose that term so her stance on quarantine would include non-citizens as well.

If she really wanted to get OUT of quarantine or have a better situation she would have suggested alternatives in the video instead of just spewing propaganda and using hot words.

It is also interesting that the FIRST person held under the new quarantine just happens to have experience writing and delivering speeches and also has ties to the CDC.

She also would have mentioned to CNN her plans to self quarantine in Maine. Something is fishy with her.